Bilobed Flap
Facial and Nose Reconstruction With a Nasolabial Flap, Skin Cancer, Kevin Kavanagh



  • Slide 1.  Surgical DefectNotice the loss of alar cartilage support and notching of the lower rim. A flap not a graft is required for reconstruction.
  • Slide 2.  Outline of Inferior Based Nasolabial Flap
  • Slide 3.  Surgical Closure
  • Slide 4.  Appearance One Week Post-OpNote the lack of significant swelling and good position of the alar rim.
  • Slide 5.  Appearance Six Weeks Post-OpNote the lack of flap swelling from lymphedema. Inferiorly based flaps have better tissue drainage.
  • Slide 6.  Appearance Ten Weeks Post-Op
  • Slide 7.  Appearance Ten Weeks Post-Op
Inferior Nasalabial Flap Reconstruction in
a Patient With a Nasal Skin Carcinoma

This flap is difficult to achieve a good cosmetic result in a single stage.  Due to both swelling and the thickness of the flap most patients will require a second-stage reduction rhinoplasty.  With wide flaps the closure of the secondary defect can also distort the nose.  With superiorly based flaps, the defect is next to the nasal ala and closure under tension may spread the nasal opening laterally.  With inferiorly based flaps, the defect is superiorly, and this can result is notching or wrinkling of the nasal ala as the superior nasal skin is pulled laterally. 
Indications for use of this flap is the loss of the nasal rim, loss of the nasal supporting cartilages (only nasal mucosa lines the depths of the resection), and a through and through defect.   If the resection is not deep, a skin graft, if possible a full thickness graft,  may be the better option since nasal distortion and flap swelling are then avoided.  A inferiorly based flap tends to swell less than a surperiorly based flap.   Full thickness skin grafts give a better cosmetic result than a nasal labial flap but should only be used for small superficial defects.

This flap is often classified as an axial flap because there is a named artery which runs deep to the flap (angular artery).  However, when used for nasal reconstruction the flap is thinned and does not contain the artery which is much deeper in the tissues.  In general, random flaps should not have a length to width ratio greater that 2.5 to 1.  Flaps wider than 1.5 cm may create a donor site which is difficult to close primarily.  In one patient, a width to length ratio of 3 to 1 was used, which resulted in partial loss of the tip of the flap.  The angular artery, a branch of the facial artery (external carotid artery system) runs deep to this flap.

Inferiorly based nasolabial flaps can be used to reconstruct lower nasal defects.  Because of the larger angle of rotation, dog-ear formation is more likely to occur.  However,  when an inferiorly based nasolabial flap is used to reconstruct nasal alar defects this dog ear tends to blend into the contour of the nasal ala.  Because the base is inferior, these flaps have better lymphatic drainage and less swelling.


Google Ad space finances and sponsors ENT USAsm Websites.  ENT USAsm, Cumberland Otolaryngology or Dr Kevin Kavanagh, MD do not endorse, recommend, referrer to or are responsible for the Advertisements or for the content or claims made in the Advertisements.

Return to:         

Copyright  2008, 2014    Cathy Kavanagh, All Rights Reserved